Healthcare Provider Details

I. General information

NPI: 1932359841
Provider Name (Legal Business Name): RATHAPHIROM COCO IV D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COCO IV D.C.

II. Dates (important events)

Enumeration Date: 09/27/2008
Last Update Date: 09/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3127 SANTA MONICA BLVD
SANTA MONICA CA
90404-2507
US

IV. Provider business mailing address

2111 CRESCENT OAK
IRVINE CA
92618-4019
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-9004
  • Fax: 310-453-9014
Mailing address:
  • Phone: 310-740-7485
  • Fax: 949-654-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number27449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: